In this application for a 36 month continuation project we propose to extend the scope of our 3 year funded project entitled, "An Ethnographic Process Evaluation of Needle Exchange, "(DA08322). Using a combination of ethnographic methods and social survey techniques, this project will build on our current study of San Francisco's Prevention point (PP) by examining the relationship between needle exchange participation and utilization of ancillary services. Specifically we will: I. Interview, observe and analyze the behavior, attitudes and expectations of the exchangers regarding the type, number and kinds of ancillary services needed and/or furnished. If ancillary services are available should they be within PP or are referrals to established agencies acceptable? How should IDUs unmet needs be addressed? A. During the first year, interview a total of 120 needle exchange participants (15 each from 8 selected sites) using an qualitative interview guide. B. During the second year, sample and interview 400 needle exchangers (50 from each of the same sites), using a survey instrument informed by the qualitative findings. II. Conduct an organizational analysis of needle exchange project sites focussing on currently developing ancillary services. A. Examine the 8 needle exchange sites in order to inventory and describe the types of ancillary services being provided. Interview 60 program providers using both qualitative depth interviews and survey methods, in order to examine their motivations, their interest in IDUs, their length of time with the organization, their views of expanding PP's services and their plans/ideas for future services. B. Describe the linkages between PP and other community services. Examine allocation of funding and staffing patterns and how these have changed over time. C. From the providers' perspective, in what way does the provision of ancillary services impact IDU's participation?